european urology supplements 9 (2010) 5, 519–530
available at www.sciencedirect.com journal homepage: www.europeanurology.com
Video posters 68 Robotic reconstruction of retrocaval ureter W. Al Khudair, M. Al Otaibi, R. Seyam, H. Al Zahrani, W. Al Taweel. Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia Objectives: Robotic reconstruction of retrocaval ureter. Methods: A 23-year-old male developed a left renal stone which passed spontaneously. In the course of evaluation for the stone he was diagnosed to have right retrocaval ureter. Laboratory investigations showed normal renal function and urine analysis. Computerized tomography showed hydronephrosis and dilatation of the upper third of the right ureter, which kinked posterior to the inferior vena cava passing to its medial then anterior surface and down to the bladder. A right retrograde study conﬁrmed the obstruction caused by the retrocaval position. Robotic uretero-uretorostomy and repositioning of the ureter were carried out electively. No part of the ureter was excised. A double J stent was inserted and removed 6 weeks later under local anesthesia. Summary of Results: Follow up computerized tomography 3 months postoperatively showed resolution of hydroureteronephrosis and the patient remained asymptomatic. Conclusions: Robotic reconstruction of the retrocaval ureter without excision of the apparently narrow retrocaval part of the ureter is associated with excellent outcome. 69 Robotic-assisted ureteric reimplantation in adults W. Al Khudair, M. Al Otaibi, H. Al Zahrani. King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia Objectives: To describe the technique of robotic assisted ureteric reimplantation in three adults. Methods: Three adult patients (15–26 years old) presented with unilateral ureterovesical stenosis, 2 left and 1 right. Summary of Results: The video will illustrate patient position, ports placement, ureteric dissection, stenting and the ureterovesical anastomosis. All cases were completed as scheduled without complications. The operative time ranged from 105–40 minutes. Stents were removed 4–6 weeks after surgery. All patients were well on follow up visits. Conclusions: Robotic assisted ureteric reimplantation simpliﬁed the minimally invasive approach and gives the patient all the advantages of minimally invasive surgery. 70 Robotic assisted pyelo-ureterostomy for obstructed left lower moiety biﬁd renal pelvis M. Al Otaibi, H. Al Zahrani. Department of Urology, King Faisal Specialist Hospital and Research Centre, Riyadh, Kingdom of Saudi Arabia
Methods: 19-year-old female, presented with few months history of left ﬂank pain, no signiﬁcant past medical history, no previous surgeries. She underwent left PCNL which was uneventful. Two days later the nephrostomy tube (NT) was clamped and the patient was experiencing signiﬁcant left ﬂank pain. There was leaking of urine around the NT. Nephrostogram showed obstruction at the UPJ. Summary of Results: The video will illustrate the surgical technique of robotic assisted left pyelo-ureterostomy in lower moiety uretro-pelvic junction obstruction in a biﬁd renal pelvis. The surgery was done in 150 minutes, it was uneventful. The patient left the hospital in 2 days. The JJ stent was removed in 6 weeks. The patient did well afterward. Conclusions: Robotic assisted pyelo-ureterostomy is a feasible procedure. The robot has made reconstructive upper tract surgery possible to do by minimally invasive technique. 71 Robot-assisted laparoscopic posterior urethral diverticulectomy in a 4-year-old boy S.M. Abumelha, F. Almodhen, A. Alshammari. Division of Urology, Department of Surgery, King Abdulaziz Medical City, King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia Objective: Posterior urethral diverticulum is a very rare presentation in the pediatric population. Most of the time followed surgical reconstruction of the imperforated anus as a sequel of recto-urethral ﬁstula. The mainstay treatment was the open surgical reconstruction. In this setting, robot-assisted laparoscopy (RAL) offers a minimally invasive option as a ﬁrst time for such a case in contrast to the literature review up to date. Method: A 4-year-old boy known case of imperforated anus was treated with perineal pull-thru at the neonatal period. The patient was complaining of inability to void with weak stream and several times retention. After voiding a cystourethrogram conﬁrmed the diagnosis of huge posterior urethral diverticulum causing intermittent bladder outlet obstruction, and the patient was taken to OR for cystoscopy and RAL posterior urethral diverticulectomy. Results: RAL provided for crisp 3D visualization, meticulous dissection, and precise approximation of the reconstructed urethra. Blood loss was negligible, narcotic use was minimal, and length of stay was one day only. Patient was discharged home on foley catheter which was removed after 6 weeks. Follow-up imaging at 2 months showed good caliber urethra with no strictures or extravasation and he was able to empty his bladder completely. Conclusion: This is the ﬁrst case to demonstrate the feasibility of RAL for posterior urethral diverticulectomy and it was comparable to the classic open procedure.
Objectives: To describe the technique of robotic assisted left pyelo-ureterostomy in lower moiety uretro-pelvic junction obstruction in a biﬁd renal pelvis. 1569-9056/ $ – see front matter © 2010 European Association of Urology. Published by Elsevier B.V. All rights reserved.